Starting next year, the single code for reflux expands into two separate choices.
Esophageal reflux can occur at all ages, but the condition “is common and often overlooked in children,” according to the Pediatric/Adolescent Gastroesophageal Reflux Association. If you see this common condition in your practice, get to know how the coding will change next year under ICD-10.
ICD-9 Coding Rules: Under the ICD-9 code set, if you see a pediatric patient and diagnose her with esophageal reflux, you currently report 530.81 (Esophageal reflux) for the visit.
Question: We had a case where the surgeon had to “redo” an old fundoplication while performing a laparoscopic hiatal hernia repair with placement of Sirgisis mesh. How should we code this, and can we separately report the fundoplication?
Plus: You could see moderate sedation changes in January.
The potential updates to Medicare’s global period rules (see the Insider Vol. 15 no. 25) are just the tip of the iceberg when it comes to the Proposed Medicare Physician Fee Schedule that CMS published last week. There are also specific coding changes that the agency has proposed which could impact the way you code your services, CMS reps said during a July 11 CMS Open Door Forum regarding the 2015 proposed fee schedule.
The following highlights reveal some possibilities that could be in the pipeline for your Medicare payments.
Enhanced efficiency may tilt the scales toward early transition.
Training your staff members about ICD-10 codes and updating your software to handle the new diagnoses is a great start to your ICD-10 transition plan, but the job isn’t completed just yet. There are a few additional steps that you’ll need to take between now and the new implementation date, experts said during CMS’s March 13 webinar, “ICD-10 Overview: Basics and Transition Tips.
Keep An Eye on ‘Non-covered’ Entities
The agency also offers an alternative claim submission method.
Although the latest ICD-10 implementation date was proposed as Oct. 1, 2015, it wasn’t set in stone — until now. On July 31, CMS announced that the 2015 date has been finalized as the deadline for ICD-10 implementation. After Sept. 30, 2015, ICD-9 codes will no longer be accepted.
Because the date has already been pushed back several times, many providers are already prepared for the transition, but should continue to stay on top of ICD-10 changes and updates as the 2015 date gets closer.
Question: We recently finished our first internal audit and found a potential issue: One of the doctors told me that he only chooses level 99212 when it is a follow-up from a previous visit. He chooses levels 99213 and above for everything else. I do not believe it is that simple because I thought even if it was not a follow-up visit, something like a minor cold might warrant 99212. Can you advise?
North Dakota Subscriber
You can get extra points under ‘management options’ for new problems…if you know what they are.
When it comes to choosing the overall level of service for an evaluation and management encounter, such as an office visit, most coders will tell you that determining the medical decision making (MDM) complexity is the most complicated and difficult piece of the puzzle. Not only is the MDM a head-scratcher, but even the individual elements under it can be tough to navigate.
Such is the case when addressing a new problem, which can snag you more points than an established one. But many practices struggle to define what makes a new problem “new.” Fortunately, one MAC stepped in to clarify this issue last week.
Background: To determine the level of MDM, you should assign points to each of the three MDM components that your doctor performs.
When a problem is found during a well visit, you may need to charge patients who expect to pay nothing.
As you are well aware by now, the Patient Protection and Affordable Care Act (PPACA) that became law in 2010 requires you to provide preventive care visits consistent with Bright Futures Guidelines for children at no cost to the patient or family, including well child exams, vision and hearing screening, immunizations, and obesity counseling, among other services.
These visits are not subject to a copay, coinsurance or deductible, so patients who schedule them come to your practice expecting to leave without paying any money out of their pockets. However,
Tip: You’ll need to specify the joint and the side.
When a patient presents with a sprain of the wrist, this means the patient presents with an injury to the ligaments of the wrist.
Currently, you have these ICD-9 options:
- 842.00, Sprain of unspecified site of wrist
- 842.01, Sprain of carpal (joint) of wrist
- 842.02, Sprain of radiocarpal (joint)(ligament) of wrist
- 842.09, Other wrist sprain
ICD-10-CM: When ICD-10 hits, you’ll have numerous more options:
Question: Our physician did an SI injection in the office without any image guidance as the C-arm was not functioning. Should I bill 20552 or 20610?